The Emotional Life of Skin

It's easy to think of the skin as a mere wrapping that protects the organs inside our body. But to understand its problems, you must realise that the skin is itself an organ, just like the heart, lungs and liver. It is the body's largest organ, and perhaps the most sensitive.

Like other organs, your skin plays its part in the complex biological orchestra of life processes. What makes the skin unique among organs is its exposed position against the outside world. Other body organs can function only in a controlled, protected environment where the temperature never varies far from 37 degree celsius. The skin maintains this environment, and to do so, it must be able to take on temperatures ranging from dry desert heat to bitter cold.

To sense and respond to the outside world, the skin is richly supplied with nerve endings that link it intimately with the body's control centre, the brain. Due to this connection, therefore, the skin is acutely sensitive to emotional events as well. It turns pale and clammy when we experience fear [the "cold sweat" of anxiety], it blushes when we're embarrassed, and it glows when we're happy.

Mind and body, sickness and health

Actually, all body organs respond to emotion, directly or indirectly, and this interconnection of mind and body may be the most important rediscovery [Hippocrates knew it; like many truths, it was often ignored for centuries] of modern medicine. Even conservative physicians now recognise that emotionally stressful events can lay the body open to various diseases.

Given the skin's intimate bonds with the nervous system, the role of the mind in skin disease should be small surprise; all the more so when you consider that psychologically as well as physically, the skin is your boundary with the world outside.

When something goes wrong with the skin - hives, eczema, warts, or whatever - my experience as a psychologist has taught me to keep the skin's double life, as emotional and physical organ, in mind; to remember that emotional difficulties can cause some skin diseases; and that even when the cause is clearly physical [such as from heredity, infection, or chemical irritation], the emotional quotient may trigger attacks or make them more severe.

Let me explain. "Emotional difficulties" doesn't mean "feelings". No matter how painful, feelings themselves cause us less trouble than our efforts to protect ourselves from them. When we don't experience the pain of difficult events, when we don't feel our feelings, we are much more prone to develop physical symptoms, including skin disorders.

Our minds and bodies are governed by what I call the Law of Conservation of Emotional Energy. We can push away the anger we're afraid will get out of control, the sexual urges we've been taught are bad, the emptiness and longing for love that parents withheld, but we can't destroy them. The feelings find their own way out to the surface, often through the skin.

Your skin, in fact, leads an emotional life of its own, filled with the feelings you've avoided in order to protect yourself against pain. Your skin feels for you: it cries and rages; it remembers events so painful you've swept them under the rug of consciousness; it punishes you for real or imagined sins.

Small changes, big effects

A persistent illness reflects a stalemate between the forces of health and disease. That's why symptoms don't get progressively worse but never get entirely better. Such forces are complex: the cause of your eczema, for example, may be 50 per cent hereditary susceptibility, 40 per cent environmental irritation, and 10 per cent emotional. Although the impact of the latter is relatively slight, improvement here can tip the balance in favour of health, promoting remission.

You can't change your heredity or eradicate the virus that causes warts or herpes but psychological techniques can minimise stress and turmoil and maximise healthy emotions to give you leverage for major improvements.

Skin diseases have a special power to torment. If even a minor skin disease is making you feel depressed, anxious, or otherwise upset, you're just reacting normally. Spare yourself the added burden of blame for feeling what anyone else would in your place.

One secret is getting to know your emotional weak points. Anyone may suffer embarrassment when he or she must present a blemished face to the world, but a person whose self-esteem is low to begin with will endure a special distress.

Understanding your conflicts, needs, and fears, your skin's emotional life, is also the most important step toward controlling the psychological factors that cause, trigger, or aggravate your disease.

A persistent skin symptom is often a message from the inner you: a call for help. Until you hear what your skin is trying to tell you, it will just repeat its message. Try to shut it up with medications or stoic indifference and it may simply cry louder. The alternative is to give your inner self what your skin is asking for, and when that is impossible, to face the pain of frustrated needs squarely and work to resolve it directly.

Think about your skin problem in a new way. Peel off the medical label you've been living with - forget you have "shingles" or "hives" or whatever - and consider your illness as a symptom of a deeper need. The first step in treating the problem under your skin is re-labelling it in psychological terms.

Unfelt, unexpressed anger.

It is the most common psychological mechanism beneath troubled skin. Since it is unsafe or unacceptable to feel anger toward others, the skin is elected to take a beating - another way that anger is directed against the self.

Your skin may be trying to take control.

People not given respect as children may spend their later lives turning the tables on the world. From the fear of being controlled may come the passion to control others. Manipulative people are desperate victims as well as victimisers. Skin diseases could be part of the arsenal employed by them in their efforts to impose.

Your skin may be playing sexual policeman

The ability to temper and postpone our urges is one thing that distinguishes humans from lower animals. It is possible to learn the lesson too well, however. The internal policeman that restrains us from grabbing immediate gratification can grow so strong that it forbids the satisfaction of perfectly legitimate needs and desires. The needs remain, but suppressed. The conflict may also be played out in the body, where the skin plays policeman to the "criminal" heart. What the skin often polices are sexual desires.

Your skin is trying to rewrite history

A persistent or new skin problem is often the echo of a battle that was lost decades before, the lasting legacy of childhood with parents who, despite their best intentions, were unable to provide the love, respect and protection their children required.

Your skin is telling forbidden truths

By subtle hints and signs, many parents tell children not to be what they are and not to feel what they feel. If the order to counterfeit oneself becomes a way of life, we learn to hide the truth from ourselves and the rest of the world. As the body's largest and most visible organ, the skin is a natural nominee for the task of truth-telling — as is evident when we blush.

Your skin is trying to stop time

The losses of time begin early. Older children lose the close nurturing they received as young children. Adolescence brings independence and frightening responsibility. The fear of time's passage freezes some lives into paralysis. We feel reluctant to close the book on a part of life where our needs were unmet. The skin's role in this is most clearly visible in the face of a man or woman who suffers from post-adolescent acne, whose "teenaged" skin shows he or she is still grappling with the conflicts of adolescence.

The psychological approach is, therefore, essential to help you understand and deal with the skin disease from an altogether different point of view. To identify how important the emotional factor is in your illness, try answering these questions. The more you answer yes, the more significant the factor.

Do your symptoms get worse or better with emotional turmoil?

Is your condition more stubborn, severe or recurrent than your doctor expects?

Are usually effective treatments not working for you?

Do most treatments work but not for long?

Is each disappearing symptom quickly replaced with another?

Do your symptoms get better or worse in an erratic, seemingly nonsensical way?

Do you see striking ups and downs in your symptoms with changes in your social environment: vacations, hospitalisations, business trips, or the comings of family members or bosses?

Do people find you strikingly stoic or unruffled in the face of stressful events?

Is your level of distress and concern about the problem strikingly high or conspicuously absent?

Is your skin worse in the morning, suggesting that you rub or scratch unintentionally at night?

Do you have trouble following your doctor's instructions?

Do you do things you know will hurt your skin, such as squeezing pimples or overexposing yourself to sunlight?

Do you feel excessively dependent on your dermatologist or excessively angry with him or her? [Even if the faults are real, are you overreacting?]

Does it seem that others notice improvements in your skin before you do? Is it hard for you to acknowledge when your skin has improved?

The involvement of a psychotherapist in your treatment of the skin disease helps you in three ways:

Exercises to help you focus on the hidden role of your emotions in the disease itself. You'll learn to know yourself and use this knowledge to make your skin better.

Techniques to reduce itching, scratching, burning, and pain - regardless of their source.

A systematic method to reduce the emotional impact of your illness so that you can cope better and suffer less while your skin improves.

Your medicines could be more effective if you identify and accept the emotional root of the problem. Think and act immediately.

Ted A Grossbart, PhD, is a licensed clinical psychologist in private practice in Boston. He is a senior clinical supervisor at the Massachusetts Mental Health Center and the Massachusetts School of Professional Psychology, and an Assistant Clinical Professor of Psychology at Harvard Medical School.His best known writing is his book SKIN DEEP: A Mind/Body Program for Healthy Skin which is available online at www.healthpress.com.

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